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Inspection on 05/12/07 for Pine Heath Nursing Home

Also see our care home review for Pine Heath Nursing Home for more information

This inspection was carried out on 5th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Pine Heath offers a service which in spite of the size of the building is still provided on a domestic scale, and ensures that the individuals living in the home are at the forefront of any plans and decisions that are made. People living in the home are involved in decisions that affect their day to day living, and a full time activity co-ordinator is available to ensure that anyone wishing to take part in activities is able to do so. People living in the home are encouraged to bring with them things that are important to them, whether this is possessions or pets, and at the present time there are birds and a cat living in the home. There are few restrictions placed on the people living in the home, and they are encouraged to maintain independent skills, for example, one resident still has his car, which he uses regularly.

What has improved since the last inspection?

Since the last inspection, some of the rooms have been redecorated, locks have been placed on all entry doors to toilets and bathrooms, and showers rooms have been renovated to ensure they are safe. A large activity room is now being used on a regular basis to provide varied events and activities, and new equipment and furniture has been provided. Although new style care plans have been introduced, further improvements are needed, as discussed later.

What the care home could do better:

The service undoubtedly puts its residents at the forefront of all decisions, and very favourable comets were received from the people we spoke to. However, their main failing is in the recording of information, and not following laid down procedures. Recruitment procedures are in place, but the information that should be available was not seen, and they must ensure that all the required checks are carried out. Records of the training that the staff undertakes must also be available, and arrangements must be put in place to ensure that all staff receive appropriate supervision, and that the provider undertakes monthly management visits.

CARE HOMES FOR OLDER PEOPLE Pine Heath Nursing Home Cromer Road High Kelling Holt Norfolk NR25 6QD Lead Inspector Mr Alan Buttery Unannounced Inspection 5th December 2007 10.30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pine Heath Nursing Home Address Cromer Road High Kelling Holt Norfolk NR25 6QD 01263 711429 01263 711488 diane.varrall@virgin.net Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Diamond Care (UK) Limited Diane Lynne Varrall Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42) of places Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: Pine Heath is a care home providing personal care and accommodation for up to 42 older people, some of whom may have dementia. It is owned by Diamond Care (UK) Ltd. The home is located on the main road between Holt and Cromer. The home consists of a two-storey building. Most of the rooms are single and of a good size. There is a passenger lift to allow easy access to all communal areas and private space. Communal space is limited, with the lounge accommodation half of what it should be for the number of registered places. However a large room just off the registered accommodation has been made into an activities room and is bright and airy. Activities take place in there every day. The grounds are attractive and extensive though would benefit from some concrete walkways so service users could enjoy them more. The manager confirmed that the fee range at the time of inspection was between £350.00 and £500.00, dependent upon the size and standard of accommodation. The fee payable can be provided in writing on request before a resident enters the home. The amount payable is included in the terms and conditions of residence given to all residents or their representative. Any changes to the fee are advised in writing. A copy of the last inspection report was in the reception area, and further copies are available on request. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, and looked at the key standards for older people. During the visit, the registered manager was available, and provided us with the required information. The annual quality assurance assessment, sent to the home in June was not received, and has therefore not been used in writing this report. During our visit, we spoke to a number of residents, and to staff working, and observed some of the residents enjoying some musical entertainment What the service does well: What has improved since the last inspection? Since the last inspection, some of the rooms have been redecorated, locks have been placed on all entry doors to toilets and bathrooms, and showers rooms have been renovated to ensure they are safe. A large activity room is now being used on a regular basis to provide varied events and activities, and new equipment and furniture has been provided. Although new style care plans have been introduced, further improvements are needed, as discussed later. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Information is gathered prior to anyone moving into the home to ensure their care needs can be met, but the information they are given must be up to date. EVIDENCE: Prior to anyone moving into the home, the manager or deputy manager completes a pre admission assessment, usually accompanied by a visit to the prospective resident. Wherever possible, the prospective resident or their family are encouraged to visit the service and spend some time looking at the facilities. Where the support is commissioned by the local authority, the service would also request a copy of their assessment, and information from any involved health professionals. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 9 Most of the people living in the home have their care funded by the local authority, although there are currently four people living at Pine Heath who pay for their own care. The admission process for them is very similar, although information may not be available from a care manager or social worker. The services Statement of Purpose and Service user guide need revision, to ensure that the correct information relating to the CSCI is available to residents and family members. The home does not offer intermediate care. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although individual plans are in place, they do not give sufficient detail to ensure the needs of people living in the home are met in a manner suited to the individual. EVIDENCE: Once the pre admission assessment has been carried out, an initial care plan is prepared ready for the admission of the new resident. This is reviewed after a few days, and full individual plans written. Examples of these were seen on the files of four people, including two people who have recently moved into the home, and these contained only very basic information, for example one plan we looked at, when describing the support needed with personal care, stated ‘needs assistance with bath’. Obviously this does not provide staff with sufficient information about the actual support required, or indicate any desired outcome. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 11 The care plans do need to be revised, to provide much more detail on the actual need, the manner in which support should be given, and the desired outcome, and must show evidence wherever possible that the person the plan relates to has been involved in its preparation. Medication records examined were in order, all staff involved in administering medication receive training, and at the time of our visit, no one living in the home had chosen to or is able to self medicate fully, although one gentleman has chosen to look after his own medication with support. The people that we spoke to or observed during the inspection were treated with respect, and staff were seen knocking on doors before entry. Since the last inspection, the toilet and bathroom doors have been fitted with locks, to ensure the privacy of the people ion the home. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. A good range of activities are available to people living in the home either in groups or individually, and the service assists people in maintaining independence wherever possible. EVIDENCE: The service has a large activities lounge, and on the day we were there, this was being used for musical entertainment, featuring wartime songs and music, and around 20 of the people living in the home were there. The room is used for as number of different activities, and the home has an activity co-ordinator. Activities are also available individually, with some residents choosing to do passive exercise or other activities in their room, and this is again supported by the co-ordinator. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 13 Other activities that people are able to join with include competitions, crafts, bingo and other games, music and movement sessions, music, regular religious services and shopping trips. Activities are normally arranged in the afternoon, which appears to suit the suit the people living in the home. At the present time, there are no residents meetings held, but it is hoped these will start in the New Year. Family visits are welcome at any time, and on the day of our visit, several family members were seen visiting their relatives. The service does try and help the people living there retain their independence, one gentleman still owns a car, and uses it to go to the shops most days, buying his newspaper or other items. A varied menu is provided, in a large dining room, with a choice of meals available every day, and fresh vegetables always available. The manager of the service advised that they do not currently have any vegetarians living in the home. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Procedures are in place to deal with complaints concerns and allegations, but people living in the home must have up to date contact information for the commission. EVIDENCE: The service has a complaints procedure in accordance with the regulations, and ensures that any concerns that are raised are appropriately investigated. However, it was noted that the information relating to the CSCI was out of date, and a revised policy needs to be written, to include the current contact information for the commission. The manager confirmed that the home has not received any complaints since the last inspection, and that there have not been any safeguarding adult issues. Procedures are in place to ensure that any allegations of abuse are properly dealt with, in accordance with the local authority procedure. The manager advised that all staff have received training in adult protection issues, but evidence of this was not available. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service offers a pleasant and safe environment to the people living there. EVIDENCE: On the day of our visit, the home was clean and tidy, and there were no offensive odours. Most of the rooms in the home are large, and many have good views over the gardens. The home is reasonably furnished, and although communal space is limited, does benefit from the large activity/function room. A previous requirement relating to locks on toilet doors has been met, ensuring that if the lobby area of the toilets is being used by someone on a commode (the cubicles are too small) the door can be locked and their privacy respected. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 16 Measures to improve the initial impressions of the home were discussed with the manager, for example the entrance to the home is rather gloomy, and would benefit from better lighting, as would the bathrooms which are quite stark and clinical rooms, with no homely feel to them. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Recruitment procedures are not being followed, and potentially putting people living in the home at risk. EVIDENCE: The recruitment procedures and staff records in the home remain poor, and during our visit, evidence was seen that new staff are employed without the required checks and information being obtained. For example, one record examined indicated that references were received after her employment started, another that they commenced work before either a CRB check or Pova first check had been obtained. Application forms do not provide enough detail, and should be re designed, and the service must ensure that gaps in employment are explored, and details of previous employments obtained. For example one record indicated through interview notes that a prospective employee had previously worked in a care home, this was not mentioned on her application, and no reference sought from the previous home. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 18 The quality of the references obtained was poor, and it was recommended to the manager that they verify all references they receive, ensuring that one is from the last employer. There was no formal record of the training being provided to staff, or copies of the qualifications that any of the staff hold, and these must be rectified. Previous inspections have requested training plans, and these must now be provided and adhered to. The manager stated that a number of the people living in the home have quite challenging needs, and staff working in the home must therefore all receive formal training in dealing with this. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although a number of management issues were noted, people living in the home are well looked after and happy. Day to day engagement with people living in the home is good, but more attention to detail and paperwork is needed. EVIDENCE: The registered manager of the service is experienced, and it was clear from our observations, and discussions with people living in the home that the service is well managed in terms of the delivery of care, and the home is run for the benefit of those living there. People we spoke to during the inspection were happy with the support provided, and spoke highly of the manager and staff. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 20 However, there appear to be ongoing problems regarding record keeping, with no evidence of staff training or formal supervision, poor care planning and record keeping. The manager advised us that senior carers are expected to undertake some supervisory work, but that this is not happening. In addition the provider is failing to carry out his management responsibilities, and is not completing the report required under regulation 26 of the care Home Regulations. Further, although the registered manager has advised us that Health and safety training is being provided to all staff, there is no record of this. Clearly, the service needs to ensure that it can provide sufficient evidence that the theses standards are being met to avoid further action being taken. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1)(f) Requirement The Statement of Purpose and service user guide must be up to date and contain correct information to ensure residents of the home have correct information. The registered persons must ensure that a service user’s plan is in place for all service users. Care plans must be developed in compliance with Schedule 3 of the Care Homes Regulations 2001. This requirement has been carried forward, and must now be complied with to avoid further legal action being taken. The registered persons must ensure all staff receive training about abuse awareness and are fully conversant with the home’s policies and procedures in this regard. Timescale for action 31/01/08 2. OP7 15 31/01/08 3. OP18 13(6) 31/01/08 Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 23 4. OP29 18(1)(a) The registered persons must ensure that robust recruitment procedures are used at all times and that documentary evidence of this process is kept available for inspection purposes. This requirement has been carried forward, and must now be complied with to avoid further legal action being taken. The registered persons must ensure a record of all staff training is maintained. This requirement has been carried forward, and must now be complied with to avoid further legal action being taken. The registered persons must ensure that all staff receive recorded supervision at least 6 times per year. This requirement has been carried forward, and must now be complied with to avoid further legal action being taken. The registered provider must ensure that visits to the home are made monthly and that a copy of the visit report is sent to the Commission. This requirement has been carried forward, and must now be complied with to avoid further legal action being taken. 31/01/08 5. OP30 18(1) 23/01/08 6. OP36 18(2)(a) 13/03/08 7. OP37 26 13/02/08 Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations It is recommended that pre-admission assessments include elements about social, emotional and physical care as well as the physical needs of the resident. Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pine Heath Nursing Home DS0000015672.V356211.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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